Last week, we looked at the social and psychological aspects of andropause. I lamented the fact that very few men are aware of the changes which take place as they approach midlife. Even if you do not want to accept these facts, then you have to explain the changes that take place as a man ages: the decrease in physical and sexual energy, which coincides with the decrease in testosterone levels, combined with a decrease in muscle and bone mass and strength.{{more}} Combine this decreasing testosterone level with an expected physiologic increase in obesity, diabetes, hypertension, cholesterol and cardiovascular disease and it’s hard to ignore these changes. So, how do we treat andropause?

Before we start treatment we need to diagnose andropause. Basically, this involves first sensitizing men to the fact of andropause. Most men, if they do not want to accept the name andropause, must accept the changes as they pass through their 40s into the 50s. These changes I have outlined above. Men need to be educated of these changes before they can be helped. We do experience the changes, but we account for their presence as the normal process of “ageing”. It is easy for a man in his 50s to acknowledge this, but it is very hard for a man in his 40s to accept these changes. It is this denial that makes andropause difficult to diagnose and treat. This denial is usually due to ignorance, so it is not a true denial. We need a social education. Men everywhere need to be educated of these changes. Education is necessary if we are to save our marriages, relationships, families, and by inference, our society. Because we do not understand the changes we are going through, then we cannot address them. Education must take place at home, at the workplace, in churches, on the radio and television, in the printed media and on the streets. In short, men need to be bombarded with the information, which should be openly discussed. Men need to be informed that the changes they are experiencing will get worse, not better. They need to be educated about effective coping strategies, not just emotional and psychological strategies, but physical strategies. Let’s look at these in more detail.

As with women going through menopause, men need emotional support from their partners and family. Just like women who have support groups for menopause, so do men. As all men must go through andropause, those who find it emotionally distressing should have the option of seeking help if they so need. Their female partners, for example, at the doctor’s office may initiate this help. Too many men come to the office without their women for a “check up”. During this time, they are diagnosed with diabetes or hypertension or high cholesterol or impotence or emotional/relationship issues and blame other factors apart from andropause. When asked to bring their partners, they are reluctant, saying such things like “Doc, why do I need to bring her, Doc? She nags too much.” It is only after 2 or 3 visits and after not following the correct instructions (due to his forgetfulness and decreasing mental alertness) that the woman eventually turns up! This is usually in response to me threatening not to see him without his wife or girlfriend and me being labeled by the man as being “difficult”. When the woman arrives, the story changes. She would complain of his poor sexual performance, his forgetfulness, his emotional outbursts and his lack of interest in sex, his drinking or his philandering with younger women, as he tries to regain his youth. This situation is not rare; it is more common than you will think!

Most men in their 40s and 50s, if asked, will admit to one or more of the emotional or psychological issues of andropause, such as forgetfulness, irritability, depression, tiredness and loss of libido. They usually call it stress or tiredness, blaming “overwork”. They will say they have not taken a holiday for years, but even when the holiday is taken as advised, they would again complain of the same symptoms weeks after returning from the vacation. Their wives or girlfriends are the ones who will have to deal with these issues. This man and this family need counselling, first to educate him and her of the changes he’s going through and then to help them find coping strategies and support. As you will expect, the man is usually reluctant to accept these changes as part of the normal process of “ageing”, called andropause, that he is going through. He prefers to call it “stress” or “overwork” or the response to a “nagging woman”. His response to these changes will usually determine the outcome of his relationship, as increasing isolation in the relationship usually follows reluctance to being treated.

The physical changes are more obvious and easier to cope with, as the reduction in muscle and bone strength can easily be slowed down by regular exercise and the use of vitamins and herbal and OTC supplements. Most men, again, will acknowledge the reduction in exercise tolerability and getting tired easily as they pass from the 40s into the 50s and worsening in the 60s. It is in the 60s that they eventually notice sagging muscles and a bending back from osteoporosis. These changes can be reduced and sometimes stopped by hormone replacement therapy, as can the emotional and psychological changes. I will be discussing hormone replacement therapy next week.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com